Surgical table and accessories to facilitate hip arthroscopy

ABSTRACT

A system includes a surgical table, a pad disposed on a table portion of the surgical table, and a leg distraction unit configured for modular attachment to the surgical table, the leg distraction unit configured to apply a distraction force to a leg of the patient while the patient is positioned on the pad and the table portion is tilted so that the patient&#39;s head is below the patient&#39;s hip, wherein the table portion is capable of tilting to a tilt angle in which the distraction force applied to the leg of the patient is counteracted by a combination of a friction force provided by the pad and a force of gravity from the patient being tilted so that the patient is kept from sliding in a direction of the distraction force.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/579,409, filed Dec. 4, 2017, which is a U.S. national stageapplication under 35 USC 371 of International Application No.PCT/US2016/036090, filed Jun. 6, 2016, which claims the benefit of U.S.Provisional Application No. 62/171,891, filed Jun. 5, 2015, and U.S.Provisional Application No. 62/250,072, filed Nov. 3, 2015. Thedisclosures of these priority applications are hereby incorporated byreference in their entireties.

TECHNICAL FIELD

Various embodiments of the present technology generally relate tosurgical tables and accessories. More specifically, some embodimentsgenerally relate to surgical tables and accessories to facilitate hiparthroscopy.

BACKGROUND

Hip arthroscopy is a surgical procedure being used with increasingfrequency as the understanding of arthroscopic management of groin painimproves. The diagnostic and therapeutic uses are numerous and mostcommonly directed at intraarticular cartilage and labral pathology.However, to access the hip joint arthroscopically, traction must beplaced on the leg to allow the surgeon access to the hip joint. Hiparthroscopy can be performed in the supine or lateral position,typically with the leg in a boot and a padded post in the groin to actas countertraction. The padded post can be used to distract the femurfrom the acetabulum, or realign fractured fragments.

The use of the perineal post has resulted in a variety of complications.For example, complications related to traction may be related to theamount of pressure of the post on the groin and the length of time thepressure is applied. In many cases the surgery may last two or morehours. Examples of complications of traction attributed to the postinclude, but are not limited to, injury of tissues, nerves (e.g.,perineal or pudendal neuropraxias), blood vessels and other structuresin the groin area. Accordingly, reliable and consistent techniques andtools to reduce the potential for complications during hip arthroscopyare beneficial.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present technology are introduced herein may bebetter understood by referring to the following Detailed Description inconjunction with the accompanying drawings, in which like referencenumerals indicate identical or functionally similar elements.

FIG. 1 is an isometric view of a surgical table and accessories inaccordance with one or more embodiments of the present technology.

FIG. 2 is an isometric view of a table extension as viewed fromunderneath that can be used in some embodiments of the presenttechnology.

FIG. 3 is an isometric view of a friction pad that can be used in one ormore embodiments of the present technology.

FIGS. 4A and 4B are top views of other friction pads that can be used invarious embodiments of the present technology.

FIG. 5 is a perspective view of a surgical table and distraction systemaccording to some embodiments of the present technology.

FIG. 6 is an isometric view of a surgical table and distraction systemwith a telescoping linear slide according to one or more embodiments ofthe present technology.

FIGS. 7A-7C are enlarged cross-sections of various linear slides thatmay be used in various embodiments of the present technology.

FIG. 8 is a perspective view of a surgical table and distraction systemaccording to some embodiments of the present technology.

FIG. 9 is a perspective view of a surgical table and distraction systemaccording to one or more embodiments of the present technology,

FIG. 10 is an isometric view of a surgical table and distraction systemaccording to various embodiments of the present technology.

FIG. 11 is a partial perspective view of a friction pad with a removableperineal post that can be used in one or more embodiments of the presenttechnology.

FIG. 12 is an enlarged partial perspective view of portion of a baseplatform that can be used in accordance with some embodiments of thepresent technology.

FIG. 13 is an enlarged partial perspective view of a sliding mechanismthat can be used in various embodiments of the present technology.

FIG. 14 is a schematic representation illustrating how various frictioncalculations can be made when a patient is in a declined position on asurgical table with the distraction system that can be used in one ormore embodiments of the present technology.

FIG. 15 is a chart illustrating coefficient of friction calculations forvarious weights.

FIG. 16 is an isometric view of a friction pad that can be used in someembodiments of the present technology.

FIG. 17 is a partial perspective view in cross-section of a materialthat can be used in one or more embodiments of the present technology.

FIG. 18 is an isometric view of a surgical table, distraction system,and accessories in accordance with one or more embodiments of thepresent technology.

FIG. 19 is an isometric view of a dual linear bearing that can be usedin accordance with one or more embodiments of the present technology.

FIG. 20 illustrates hinges in an arm of a distraction system inaccordance with one or more embodiments of the present technology.

FIG. 21 illustrates a telescoping support post of a distraction systemthat can be used in accordance with one or more embodiments of thepresent technology.

FIG. 22 illustrates a leveling caster of a distraction system inaccordance with one or more embodiments of the present technology.

FIG. 23 is a side view of a distraction system with carbon fibercomponents in accordance with one or more embodiments of the presenttechnology.

FIG. 24 illustrates an end post design of a distraction system inaccordance with one or more embodiments of the present technology.

FIG. 25 illustrates a locking stability mechanism of a distractionsystem that can be used in accordance with one or more embodiments ofthe present technology.

FIG. 26 is an isometric view of an alternate frame design using lowerfixed rail and fixed geometry of a distraction system in accordance withone or more embodiments of the present technology.

FIG. 27 illustrates telescoping horizontal beam using a clevis pin inaccordance with one or more embodiments of the present technology.

FIG. 28 is an isometric view of a frame design in accordance with one ormore embodiments of the present technology.

FIG. 29 illustrates an anchoring bracket that can be used to secure abase of a distraction system to a surgical table in accordance with oneor more embodiments of the present technology.

FIG. 30 illustrates an abduction joint with integrated roller bearing inaccordance with one or more embodiments of the present technology.

FIG. 31 illustrates a caster and leveling foot assembly of a distractionsystem that can be used in accordance with one or more embodiments ofthe present technology.

The headings provided herein are for convenience only and do notnecessarily affect the scope or meaning of the claimed embodiments.Further, the drawings have not necessarily been drawn to scale. Forexample, the dimensions of some of the elements in the figures may beexpanded or reduced to help improve the understanding of theembodiments. Moreover, while the disclosed technology is amenable tovarious modifications and alternative forms, specific embodiments havebeen shown by way of example in the drawings and are described in detailbelow. The intention, however, is not to limit the embodimentsdescribed. On the contrary, the embodiments are intended to cover allmodifications, equivalents, and alternatives falling within the scope ofthe embodiments as defined by the appended claims.

DETAILED DESCRIPTION

The following description provides specific details for a thoroughunderstanding and enabling description of these examples. One skilled inthe relevant art will understand, however, that the techniques discussedherein may be practiced without many of these details. Likewise, oneskilled in the relevant art will also understand that the technology caninclude many other features not described in detail herein.Additionally, some well-known structures or functions may not be shownor described in detail below so as to avoid unnecessarily obscuring therelevant description.

The terminology used below is to be interpreted in its broadestreasonable manner, even though it is being used in conjunction with adetailed description of some specific examples of the embodiments.Indeed, some terms may even be emphasized below; however, anyterminology intended to be interpreted in any restricted manner will beovertly and specifically defined as such in this section.

Various embodiments of the present technology generally relate tosurgical tables and accessories. More specifically, some embodimentsgenerally relate to surgical tables and accessories to facilitate hiparthroscopy. Traditional techniques for performing distraction of thehip joint during arthroscopy, or while performing reduction of hipfractures, utilize a perineal post against which the pressure todistract the femur from the acetabulum, or realign the fracturedfragments, is transferred. This pressure can, in some instances, fail tosufficiently protect tissues, nerves, blood vessels and other anatomicalstructures in the groin. As discussed below, various embodiments of asurgical table system in accordance with the present disclosure providenew devices and methods for performing hip distraction without the useof the perineal post, or with minimized pressure on the perineal post,if used.

In accordance with various embodiments, the distraction system may beattached to a surgical table along with a variety of accessoriesdesigned to facilitate hip distraction, hip fracture reduction andfixation, or anterior approach hip replacement procedures, with orwithout a perineal post. FIG. 1 is an isometric view of a surgical tableand accessories in accordance with one or more embodiments of thepresent technology.

In the embodiment illustrated in FIG. 1 , a distraction system 1 isattached to a surgical table 2. In some embodiments, the distractionsystem 1 can include beams or arms 3 connected to base 4 via adjustablejoints 5. The beams 3 and base 4 can be secured to surgical table 2 withadjustable locking mechanisms 6 to allow the distraction system 1 tomodularly attach to a variety of surgical tables 2, including retrofitof distraction system 1 to pre-existing surgical tables. For example, inthe illustrated embodiment, the table 2 includes a table portion sizedand configured to receive and support a patient and a pedestal footsized to provide a stable support for the table portion. In otherembodiments, base 4 may be integrally and/or monolithically formed as apart of the pedestal foot of table 2, obviating the need for a separatelocking mechanism 6.

In some embodiments, the table 2 is configured to allow the tableportion to tilt relative to the pedestal foot, such that the plane ofthe patient support surface forms angle θ (FIG. 14 ) with respect thepedestal foot (and the floor of the room in which system 1 isinstalled). Angle A, shown in FIG. 1 as the angle between the patientsupport surface and the vertical axis of the stanchion linking the tableportion with the pedestal foot, is complementary to angle θ (i.e.,θ=90−A). Such tilting of the table portion may be used to position thehead of the patient below the hip of the patient, e.g., in theTrendelenburg position, as further described below. For purposes of thepresent discussion, a positive value of angle θ corresponds to aTrendelenburg tilt in which the patient's head is lower than thepatient's hip.

The beams 3 may be solid or hollow in various embodiments. The beams 3may include one or more rounded transition points in some embodiments.In accordance with some embodiments, these components of distractionsystem 1 can be made of various materials (e.g., aluminum, carbon fiber,etc.) to provide a balance between strength and light weight for moving,

Locking mechanisms 6 may be removable from base 4 to allow differentlocking mechanisms to be selected (e.g., to ensure compatibility betweenthe configuration or model of surgical table 2 and the configuration ofdistraction system 1). In some embodiments, locking mechanisms 6 mayinclude a bracket with an open end that allows the locking mechanisms 6to wrap around a portion (e.g., a foot or post) underneath the surgicaltable when slid along the elongated openings 4.5 in base 4. Other typesof locking mechanisms may be used as long as the base 4 is securelyattached to the surgical table 2 to prevent sliding or twisting.

The distraction system 1 can have a variety of adjustable parts (e.g.,adjustable joints 5 and adjustable posts 8) to accommodate patients witha variety of heights from short to tall. Adjustable joints 5 allow thebeams 3 to be rotated about pivot shafts 5.5 (which define a generallyvertical pivot axis) into a desired medial/lateral position. Forexample, the beams 3 may be positioned far enough apart to allow forvarious medical equipment (e.g., imaging equipment) to be positionedbetween the beams 3. In addition, adjustable joints 5 and adjustableposts 8 can enable disassembly of the unit for transport or storage.

Support posts or stanchions 8 can include locking casters 9 to allow forangular adjustment (e.g., hip adduction and abduction). In accordancewith some embodiments, locking casters 9 may be replaced (orsupplemented) with other support mechanisms to prevent movement andlateral translation of the support posts 8. Examples of other supportmechanisms include, but are not limited to extendable tri-pod likestands and extendable supports.

Support posts or stanchions 8 can include a gear box 10 to allow forvertical adjustment of equipment. Other embodiments may use a simpleslide/clamp mechanism instead of the gear box 10. Locking linear slides7 may be used in some embodiments to couple the beams 3 to the posts 8.The locking linear slide 7 may be used to pull a boot, foot support orother distal patient restraint away from surgical table 2 to apply grosstraction for distraction of the femur. In some embodiments, othersuitable linear adjusters may be used. For example, linear adjustmentmechanisms for applying traction may be used as described herein,including telescoping linear slides.

An upper support post with a mount 11 having standard surgical tablerail dimensions allows for attachment of any standard surgical tableequipment (e.g., hip positioning systems such as padded boots, footsupports or other distal patient restraints). Additionally, a genericmount 12 may be present at the upper end of the support post forfixation of other equipment either custom or generic. Moreover, anysupport post arrangement, with a separately affixed orintegral/monolithic patient restraint may be used in the presenttechnology. As described herein, support posts may extend upwardly fromlinear slide 7 (or other linear actuators as described herein), as wellas downwardly therefrom in a variety of potential configurations.

Some embodiments of the present technology include table extension 13that allows for positioning of the patient on the distal end of thesurgical table 2. In some embodiments, the table extension 13 isradiolucent to allow for radiographic imaging of the patient through thetable extension. An optional perineal post 14 may be provided anddesigned to accommodate positioning for either right or left sideprocedures. In some embodiments, the distraction system does riotinclude a perineal post. Instead, the traction force is provided by afriction pad 15 and/or the tilt angle θ of the table 2, as seen in FIG.14 and explained more fully below.

With reference to FIG. 2 , the table extension 13 may be provided indifferent sizes that can be selected based on the size of the patient,with larger sizes used for larger patients in order to provide for alarger support surface area and greater frictional interaction betweenthe patient and the support surface of extension 13. Also, someembodiments of the table extension 13 can include an elongated aperture16 in which a supporting extension 17 of the perineal post 14 can beoptionally attached as desired by a surgeon. The elongated aperture 16allows the perineal post to be laterally positioned depending upon theoperating leg of the patient. Other embodiments (not shown), may includetwo or more apertures which provide a series of fixed positions for theoptional perineal post. Still yet, some embodiments of table extension13 may not allow for a perineal post to be attached, or may not have aperineal post installed in aperture 16. The table extension 13 caninclude an adjustable attachment mechanism 18 that can be used to securethe table extension 13 to surgical tables of different widths (e.g.,nineteen inches, twenty inches, etc.). In the illustrated embodiment,attachment mechanism 18 includes a pair of attachment arms engaged(e.g., frictionally) with the lateral surfaces of the table portion ofsurgical table 2 (as shown in FIG. 1 ) in order to fix table extension13 to the distal end of the adjacent patient support surface. Of course,it is contemplated that any suitable attachment mechanism 18 may be usedfor such fixation, including fasteners, adhesives, or the like. In someembodiments, table extension 13 may be integrally and/or monolithicallyformed as a part of the table portion of surgical table 2, obviating theneed for a separate attachment mechanism 18.

A friction pad 15 can be mounted to an upper surface of extension 13,and can be used in conjunction with the weight of the supported patientto generate forces opposing the distraction force. In combination withthe tilt angle θ (e.g., Trendelenburg tilt) of the table, the frictionalforces created by friction pad 15 may negate or minimize the need for acounter-traction perineal post. In some embodiments, the addition of aside-tilt of less than 2 degrees (e.g., 0.5 to 2.0 degrees) on thecontra-lateral side can further reduce the need for a counter-tractionperineal post. The pad may be sized to contact only a portion of thesupported patient's body (e.g., lower back, buttocks) to generate lowerlevels of opposing force as required or desired for a particularapplication. Alternatively, the pad may extend the entire length of thesupported patient's torso to generate increased levels of opposing forceas may be required or desired for other applications.

FIG. 3 illustrates an exemplary friction pad 15 which can be used in oneor more embodiments of the present technology. In accordance withvarious embodiments, the friction pad 15 may fit over table extension13. Friction pad 15 may include a composite polymeric patient-contactingpad layer 15.1 that can be used to generate a coefficient offriction >0.52 as measured between human skin and the surface of the pad15.1. For example, friction pad 15.1 may be a polymer-polymer orpolymer-textile composite in various embodiments.

Additionally, an additional polymeric table-contacting layer 15.3 may beused in some embodiments to generate a coefficient of friction >0.52 asmeasured between the pad and the abutting surface of the surgical table2. The middle layer 15.2 of the pad 15 can be designed to providecushioning and support for the patient and to create a level surfacebetween the surgical table 2 and the extension 13. The friction pad 15may be a disposable pad which can be thrown away at the end of each use.In some embodiments, the friction pad 15 may be a disposable, sheet likecovering for reusable surgical table cushions.

FIGS. 4A and 4B are top views of other friction pads 15 that can be usedin various embodiments of the present technology. In addition to thefunctions previously described for the friction pad 15, theseembodiments of the friction pad 15 are designed to extend past the tableextension 13 and cover all or part of the length of the surgical table 2and provide restraint for the patient's arms during the procedure. Theadditional wrapping portions of the friction pads 15 that are used toassist in restraining the patient may include one or more aperturesallowing access for fluid delivery or the like. As a result, one side ofthe friction pad 15 may generate friction as the patient is positionedthereupon and the access material can be positioned (e.g., wrapped)around the patient to secure his hands or arms. The patterned materialfor wrapping and securing the arms of the patient may be the same ordifferent material found on the rest of the friction pad (e.g., theportion that would be underneath the patient's back). In addition,friction pads 15 may be made of a flame resistant or flame retardantmaterial.

FIG. 5 is a perspective view of a surgical table 25 and distractionsystem 21 according to another representative embodiment of the presenttechnology. Table 25 and distraction system 21 may be similarlyconstructed to table 2 and distraction system 1 described in detailabove, with like structures having like functions except as otherwisedescribed below.

In the embodiment shown in FIG. 5 , the support posts 28 have beenrelocated from the embodiment shown in FIG. 1 , to decouple the angularpositioning (adduction and abduction) from the gross traction mechanism27. Thus, in the embodiment of FIG. 5 , gross traction mechanism 27(which operates similar to locking linear slide 7 described above) maybe actuated without moving support posts 28. Support posts 28 mayinclude fixed footers at their ground-contacting surfaces, rather thanlocking casters 9, of distraction system 1 (FIG. 1 ), since posts 28need not translate during distraction. Alternatively, locking casters 9may be provided on posts 28 to facilitate medial/lateral pivoting ofbeam members 23.

FIG. 11 is an enlarged, partial perspective view of the table extension29 shown in FIG. 5 . Table extension 29 allows for positioning of thepatient on the distal end of the surgical table 25, similar to tableextension 13 described in detail above with respect to surgical table 2.An optional perineal post 30 may be provided and designed to accommodatepositioning for either right or left side procedures, similar toperineal post 14 also described in detail above.

Other embodiments of the present technology, while not pictured, caninclude a linear slide mechanism incorporated into the beam members 23to minimize weight and size of the invention. In such an embodiment, aD-shaped, dovetail, or double dovetail profile for the beam members 23,with a locking clamp, may be used in place of gross traction mechanism27 to apply gross traction. Additionally, in some embodiments, a finetraction adjustment mechanism may be added using a linear/rotary motionconversion mechanism, such as a worm gear or a trapezoidal threaded rod(sometimes referred to as an acme rod) and correspondingly threadedrotary bushing. Such a fine adjustment assembly may be used, forexample, to allow for a mechanical reduction such that movement of aninput (e.g., a hand wheel or motor mandrel) is translated to acorresponding but reduced linear movement of the distal patient support.

FIG. 6 illustrates another conceptual representation of a perspectiveview of a surgical table 32 and distraction system 31 with a telescopinglinear slide 19 on each of the beam members 33 according to one or moreembodiments of the present technology. FIGS. 8-10 provide variousperspective views of the surgical table 32 and the distraction system 31introduced in FIG. 6 .

FIGS. 7A-70 are enlarged cross-sections of various linear slidesmentioned above that may be used in various embodiments of the presenttechnology. For example, FIG. 7A illustrates a D-shaped slide profile35; FIG. 7B illustrates a dovetail slide profile 37; and FIG. 70illustrates a double dovetail slide profile 39. In some embodiments, anadditional wheel type handle may be present in some embodiments to allowfor fine traction adjustment, such as by linear/rotary motion conversionmechanism as discussed above. Other embodiments may include slidingfeatures that may be electro-mechanically, pneumatically, orhydraulically adjustable (e.g., either actively or passively). Someembodiments may use a combination of sliding and controlledlinear/rotary (e.g., acme rod) adjustment along beam members 33 tofacilitate gross traction in patient on surgical table 32.

FIG. 12 is an enlarged partial view of a representative embodiment of abase platform 40 that can be used in accordance with some embodiments ofthe present technology. The beam 43 may allow for length adjustmentsnear base platform 40 using a pin system (e.g., clevis pins) 42 thatjoin nested or telescoping tubing segments in various discretelength-adjustment configurations. The base platform 40 may also includelocking/leveling casters 45 for support and adjustment of base platform40 relative to, or in conjunction with, the surgical table (e.g.,surgical table 2 shown in FIG. 1 ).

FIG. 13 is an enlarged partial perspective view of a sliding mechanism47 that can be used in various embodiments of the present technology.The sliding mechanism can provide linear gross traction and/or finetraction and can be used in conjunction with any of the distractionsystem described herein to provide for linear movement. Similar tolocking linear slides 7 described above with respect to FIG. 1 , slidingmechanism 47 may be actuated to move mount 12 (and/or any attached orother distal patient restraint) towards or away from the surgical tableto reduce or increase traction, respectively. Sliding mechanism 47 canbe locked in position with locking clamp 24. In the illustratedembodiment, support posts or stanchions 8 in conjunction with gearbox 10allow for vertical adjustment of equipment though other arrangements maybe used (e.g., the arrangement of FIG. 5 ).

FIG. 14 is a schematic representation illustrating how various frictioncalculations can be made when a patient is in a declined position on asurgical table with the distraction system that can be used in one ormore embodiments of the present technology. FIG. 15 is a chartillustrating coefficient of friction calculations based on an angle θfor various weights (i.e., the weight of a patient or a portion of apatient received on a patient support surface, as described herein, isthe product of the mass m of the patient or portion of the patient andgravity g). The friction pad 15 illustrated in FIG. 1 can be selected toadjust the friction coefficient. As a result, the patient resting uponthe patient support surface of surgical table 2 can be placed in atilted position at a desired angle θ. This combination of tilting andfriction generates a force which is a function of the Trendelenburgangle θ, the mass m of the patient, and the coefficient of friction μ ofthe friction pad 15 as detailed in FIG. 14 . For a given patient mass m,the Trendelenburg angle θ and the coefficient of friction p can beselected to provide a desired force F_(μ) to sufficiently counteract therequired or desired traction force F_(T), which acts directly oppositeforce F_(μ) as shown. These counteracting forces will keep the patientin place while allowing the surgeon to generate enough traction forceF_(T) on the leg of the patient to gain access to the central hip jointcompartment of the patient without the use of a perineal post or tominimize pressure between the patient and a perineal post forconfigurations including a perineal post is used. In some embodiments,the angle θ can vary in the range from about 0 degrees to about 25degrees, while the coefficient of friction p may also be varied togetherwith the area of contact between the patient and the friction pad 15 inorder to generate the necessary counteracting forces. Variouscombinations and permutations of these variable factors are illustratedin the tables of FIG. 15 to provide a sampling of potentially viablecombinations based on patient weight.

FIG. 16 is an isometric view of a friction pad 50 that can be used insome embodiments of the present technology. The friction pad 50illustrated in FIG. 16 does not include a cutout for a perineal post,though such a cutout may be provided as described above with respect tofriction pad 15.

FIG. 17 is a partial perspective view of a friction pad material 52 thatcan be used in one or more embodiments of the present technology. Asillustrated, a series of angled ridges may be provided in thepatient-support surface of pad material 52. In one embodiment, theseridges may be oriented to point generally opposite the direction offorce F_(μ) (FIG. 14 ) when friction pad 50 is in use, such that acompressive force is placed on the ridges. Each ridge may thereforeresiliently deform when the patient is resting on pad 50, presenting abarrier to sliding movement of the patient, upon the patient supportsurface, effectively increasing the coefficient of friction p of the padmaterial 52.

FIG. 18 is an isometric view of a surgical table 54, distraction system56, and various accessories in accordance with one or more embodimentsof the present technology. Distraction system 56 is arranged similar todistraction system 7 shown in FIG. 1 and described in detail above,except that the linear bearings 58 and support posts 60 are differentlyarranged as described further below.

FIG. 19 is an isometric view of the dual linear bearing 58 used indistraction system 56 introduced in FIG. 18 . As illustrated, duallinear bearing 58 uses one bearing along the bottom of the linear slide,and a second bearing along the top of the linear slide. The bottom andtop bearings may be independently adjustable. The dual linear bearings58 (slides) illustrated in FIG. 19 can be used in some embodiments toenhance support of the transverse loads on the support posts 60.

FIG. 20 illustrates hinges 64 in an arm or beam 62 of a distractionsystem 56 in accordance with one or more embodiments of the presenttechnology. In the embodiments illustrated in FIG. 20 , the arms 62 ofthe distraction system 56 include hinges 64 to adjust the angle of thearm 62 with respect to the floor. This feature may allow for a betterfit of the system to an individual patient.

FIG. 21 illustrates a telescoping support post 60 of a distractionsystem 56 that can be used in accordance with one or more embodiments ofthe present technology. As illustrated in FIG. 21 , the support posts 60above and below the linear bearings 58 (slide) include a telescopingfeature which also helps fit the system to an individual patient.

FIG. 22 illustrates a leveling caster 68 of a distraction system 56 inaccordance with one or more embodiments of the present technology. Theleveling casters 68 can be used to ensure the distraction system 56maintains equal contact with the floor under all loading scenarios.

FIG. 23 is a side view of a distraction system 56 with carbon fibercomponents in accordance with one or more embodiments of the presenttechnology. In some embodiments, the beams 62, support posts 60, and/orother components may be made of carbon fiber. Carbon fiber tubing canreplace aluminum tubing in order to produce a lighter, stronger, andstiffer distraction system 56.

FIG. 24 illustrates an end post assembly 66 of a distraction system inaccordance with another embodiment of the present technology. Thesupport of the linear bearing 70 is shifted to an ‘end-post’ design inorder to allow for a single sliding surface on linear bearing 70 whenpulling traction. As illustrated in FIG. 24 , the end post design cansupport the weight of the distraction system independent from slidingsurface of bearing 70.

FIG. 25 illustrates a locking stability mechanism 72 of a distractionsystem that can be used in accordance with one or more embodiments ofthe present technology. The handle 74 shown is configured to lock thearm 62 in a desired adduction degree configuration, limiting oreliminating the freedom of arm 62 to move when so locked. This lockingcan be used to improve stability of the distraction system.

FIG. 26 is an isometric view of an alternate distraction system 76 usinga lower fixed rail 78 and fixed geometry for the distraction system inaccordance with one or more embodiments of the present technology. Thealternate frame design illustrated in FIG. 26 provides for a lower arail 78 closer to the ground. In some embodiments, the frame may be madeout of machined aluminum. The rail components may be fixed in length andgeometry. The post 80 is telescoping in order to adjust the height ofmount 12 (and/or any attached or other distal patient restraint). Thedegrees of abduction may be varied but no locking mechanism is required.Traction may be achieved by sliding the post 80 along the rail 78, andmay be locked in place by actuation of locking handles 81. Distractionsystem 76 is shown attached to a surgical table, and may be used inconjunction with any suitable surgical table as described herein withrespect to other embodiments of the present technology.

FIG. 27 illustrates telescoping horizontal beam 82 using a clevis pin 84similar to that described above with respect to FIG. 12 . A telescopinghorizontal beam 82 using a clevis pin 84 which allows for adjustedlength of the frame with respect to the surgical table. The beam 82 canbe adjusted among various discrete length configurations by movingclevis pin 84 between a plurality of adjustment apertures 88. In someembodiments, the clevis pin 84 is retained in position with a cotter pin86. Locking handle 74, described above with respect to FIG. 25 , mayalso be provided to lock the adduction angle of beam 82.

FIG. 28 is an isometric view of a distraction system 90 in accordancewith another representative embodiment of the present technology. Thedistraction system 90 integrates roller bearings 92 into the abductionjoint 94 and uses a single steel square arm tube 96 to mount the rail98. Each arm 96 rotates about an associated vertically oriented axiscorresponding to the axis of bearing 92, to provide for hip adductionand abduction of a patient's leg. The rail 98 is mounted to the topportion of the square tube 96 to allow for gross traction. The joint 94is located at a proximal end 101 of arm 96 and a caster and levelingfoot assembly 100 supports the distal end 102 of the square tube 96.Distraction system 90 is shown attached to a surgical table, and may beused in conjunction with any suitable surgical table as described hereinwith respect to other embodiments of the present technology

FIG. 29 illustrates an anchoring bracket 104 that can be used to securea base 106 of the distraction system 90 to a surgical table 108 inaccordance with one or more embodiments of the present technology. Thefeet 110 of the surgical table 108 secure the bracket 104 to the floor;then leveling screws 112 cause compression between base 106 and thesurgical table 108. Horizontal and vertical slots 114 and 116,respectively, allow the bracket 104 to be maneuvered under the feet 110of the surgical table 108 and/or lifted off the ground when the table isrolling or otherwise being repositioned. Bracket 104 is also shownattached to table 108 in FIG. 30 .

FIG. 30 illustrates an abduction joint 94 with integrated roller bearing92 in accordance with one or mare embodiments of the present technology.The roller bearing 92 is integrated into the abduction joint 94 in orderto allow for smooth motion and to prevent torsional loads fromdeflecting the arm 96. The bearing 92 withstands the lifting momentproduced when the patient's leg is in traction and therefore maintainsthe stability of the frame.

FIG. 31 illustrates the caster and leveling foot assembly 100 of thedistraction system 90 (FIG. 28 ) that can be used in accordance with oneor more embodiments of the present technology. A caster 120 and levelingfoot 122 provide for both motion of the arm 96 about the abduction jointand also stability when the leveling foot 122 is lowered by actuation ofjack screw 125 via adjuster knob 124.

Methods related to distracting the hip joint are also disclosed, such asa method for distracting the hip joint where the force resisting thedistraction force is applied not through the use of a perineal post butthrough a combination of: 1) tilting the patient backward at an anglebetween 2 degrees and 20 degrees from the horizontal; and 2) placingfabric or material that produces increased frictional resistance betweenthe patient's back and the underlying

In an embodiment, a method for distracting a patient's hip jointincludes applying a distraction force to the patient's leg and resistingthe distraction force without the use of a perineal post. The resistingcan include tilting the patient backward on a support surface relativeto the patient's leg at an angle between 2 degrees and 20 degrees fromhorizontal and placing a friction increasing material between thepatient and the support surface. In some embodiments, the method furthercomprises tilting the support surface to a contra-lateral side relativeto the patient's leg at an angle between 0.5 and 2 degrees fromhorizontal.

In another representative embodiment, a method of configuring a surgicaltable as a distraction system includes attaching a distraction systembase to a base portion of the surgical table and rotatably coupling apair of arms to the distraction system base. The method can also includeattaching a table extension to a table portion of the surgical table andpositioning a friction pad on the table extension. In some embodiments,the table portion is tilted away from the distraction system base at anangle between 2 degrees and 20 degrees from horizontal. In someembodiments, each arm rotates about an associated vertically orientedaxis. In some embodiments, the method includes connecting an upwardlyextending support post to each of the pair of arms and/or tilting thetable portion toward a lateral side of the surgical table at an anglebetween 0.5 and 2 degrees from horizontal.

The above description and drawings are illustrative and are not to beconstrued as limiting. Numerous specific details are described toprovide a thorough understanding of the disclosure. However, in someinstances, well-known details are not described in order to avoidobscuring the description. Further, various modifications may be madewithout deviating from the scope of the embodiments. Accordingly, theembodiments are not limited except as by the appended claims.

Reference in this specification to “one embodiment” or “an embodiment”means that a particular feature, structure, or characteristic describedin connection with the embodiment is included in at least one embodimentof the disclosure. The appearances of the phrase “in one embodiment” invarious places in the specification are not necessarily all referring tothe same embodiment, nor are separate or alternative embodimentsmutually exclusive of other embodiments. Moreover, various features aredescribed which may be exhibited by some embodiments and not by others.Similarly, various requirements are described which may be requirementsfor some embodiments but not for other embodiments. The features of thevarious embodiments of the present technology disclosed herein may beused in any combination or permutation, unless explicitly specifiedotherwise. For example, various linear-motion devices shown anddescribed in the present disclosure may be utilized in any combinationat the various linear-motion junctions between structures, as requiredor desired for any particular application of the present technology.

The terms used in this specification generally have their ordinarymeanings in the art, within the context of the disclosure, and in thespecific context where each term is used. It will be appreciated thatthe same thing can be said in more than one way. Consequently,alternative language and synonyms may be used for any one or more of theterms discussed herein, and any special significance is not to be placedupon whether or not a term is elaborated or discussed herein. Synonymsfor some terms are provided. A recital of one or more synonyms does notexclude the use of other synonyms. The use of examples anywhere in thisspecification, including examples of any term discussed herein, isillustrative only and is not intended to further limit the scope andmeaning of the disclosure or of any exemplified term. Likewise, thedisclosure is not limited to various embodiments given in thisspecification. Unless otherwise defined, all technical and scientificterms used herein have the same meaning as commonly understood by one ofordinary skill in the art to which this disclosure pertains. In the caseof conflict, the present document, including definitions, will control.

1. (canceled)
 2. A system comprising: a surgical table comprising apedestal portion for positioning on a floor and a table portion forsupporting a patient, wherein the table portion is tiltable to positiona head of the patient below a hip of the patient; a pad disposed atleast partially on a surface of the table portion of the surgical table;and a leg distraction unit configured for modular attachment to thesurgical table, the leg distraction unit configured to apply adistraction force to a leg of the patient while the patient ispositioned at least partially on the pad and the table portion is tiltedso that the head of the patient below the hip of the patient, whereinthe table portion is capable of tilting to a tilt angle in which thedistraction force applied to the leg of the patient while the patient ispositioned at least partially on the pad and the head of the patient isbelow the hip of the patient is counteracted by a combination of afriction force provided by the pad and a force of gravity from thepatient being tilted so that the patient is kept from sliding in adirection of the distraction force while the distraction force is beingapplied to the leg of the patient.
 3. The system of claim 2, wherein thetable portion is configured for tilting at an angle in a range of 2 to20 degrees from horizontal.
 4. The system of claim 2, wherein the pad isdisposed so as to be positioned under at least one a torso of thepatient.
 5. The system of claim 2, wherein the pad is disposed so as tobe positioned under at least one of a lower back and a buttocks of thepatient.
 6. The system of claim 2, wherein the pad is a foam pad.
 7. Thesystem of claim 2, wherein the pad has a coefficient of friction that isin a range of 0.3293 to 2.3202 as measured between human skin and asurface of the pad.
 8. The system of claim 2, wherein the pad has acoefficient of friction that is at least 0.52 as measured between humanskin and a surface of the pad.
 9. The system of claim 2, comprising atable extender that is selectively attachable to the table portion forsupporting at least a portion of the patient while the distraction forceis being applied to the patient.
 10. The system of claim 9, wherein aportion of the pad is positioned on at least a portion of the tableextender.
 11. The system of claim 9, wherein at least a portion of thetable extender is radiolucent.
 12. The system of claim 9, wherein thetable extender comprises a perineal post.
 13. The system of claim 9,wherein the table extender is configured for adjustable attachment tothe table portion.
 14. The system of claim 2, wherein the system doesnot include a perineal post.
 15. The system of claim 2, wherein the legdistraction unit is attachable to the pedestal portion.
 16. The systemof claim 2, wherein the leg distraction unit comprises a floor supportpost for supporting the leg distraction unit on the floor at a locationthat is spaced from the pedestal portion.
 17. The system of claim 16,wherein the floor support post comprises a wheel for rolling on thefloor.
 18. The system of claim 2, wherein the leg distraction unitcomprises a base that is attachable to the surgical table and at leastone arm that extends from the base for supporting the leg of thepatient.
 19. The system of claim 18, wherein the at least one arm isrotatable relative to the base.
 20. The system of claim 18, wherein theleg distraction unit comprises a boot support movably mounted to the atleast one arm and configured for mounting a boot, wherein the bootsupport is movable relative to the at least one arm for applyingtraction to the leg of the patient.
 21. The system of claim 18, whereinthe base comprises at least one bracket for securing the base to thesurgical table.